Document Detail

Predicting the outcome of invasive treatment of renal artery disease.
MedLine Citation:
PMID:  10672137     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Analysis of the factors influencing the outcome of performed or attempted invasive treatment for renal artery disease (RAD).
SETTING: University Hospital.
STUDY PATIENTS: Thirty-five hypertensive patients with 31 stenoses and 14 occlusions of renal artery.
INTERVENTIONS: Angioplasty was performed on 25 patients (attempted for 30), primary stenting on one, nephrectomy on three, and renal resection on one patient.
MAIN OUTCOME MEASURE: A decrease of diastolic blood pressure (DBP) by >/=15 mmHg after intervention.
RESULTS: A DBP response was seen in 24 patients. In 11 patients, invasive treatment did not result in a DBP response or failed technically. Compared with these patients, the responders were younger (55 +/- 11 vs. 66 +/- 8 years, P = 0.001) and tended to have higher DBP (100 +/- 8 vs. 93 +/- 11 mmHg, P = 0.065). The function of the affected kidney, or that of the more affected kidney if RAD was bilateral, was better preserved in responders (relative clearance on captopril renography 23 +/- 15 vs. 8 +/- 4%, P = 0.008). A response was more often seen in unilateral than in bilateral RAD (81% vs. 33%, P = 0.015). A relative clearance of </=10% on captopril renography had sensitivity of 88% and specificity of 81% for renal artery occlusion. Step-wise logistic analysis. (1) When DBP was< 95 mmHg with two antihypertensives, the response rate was 1/6 vs. 24/29 for more severe hypertension (P = 0.004). (2) Elderly patients had a response rate of 2/5 vs. 22/24 in younger patients (P = 0.024). (3) Response rates in bilateral and unilateral disease were not different, nor did the function of the affected kidney impact the DBP response. However, three of the four responders with </=10% relative clearance had an occluded renal artery and underwent nephrectomy.
CONCLUSIONS: Middle-aged patients with easily controlled hypertension and elderly hypertensives do not usually have a blood pressure response to the performed or attempted invasive treatment of RAD. Therefore, it seems recommendable not to screen such patients for RAD, unless their renal function is deteriorated. If the affected kidney functions poorly on captopril renography, angioplasty is usually not applicable and seldom leads to a blood pressure response.
K H Helin; M Lepäntalo; J Edgren; K Liewendahl; T Tikkanen; I Tikkanen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of internal medicine     Volume:  247     ISSN:  0954-6820     ISO Abbreviation:  J. Intern. Med.     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2000-03-01     Completed Date:  2000-03-01     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  8904841     Medline TA:  J Intern Med     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  105-10     Citation Subset:  IM    
Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland.
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MeSH Terms
Antihypertensive Agents / diagnostic use
Blood Pressure
Captopril / diagnostic use
Hypertension, Renovascular / blood,  complications*,  physiopathology
Middle Aged
Predictive Value of Tests
Radioisotope Renography / methods
Renal Artery Obstruction / etiology,  physiopathology,  radiography,  surgery*
Renin / blood
Retrospective Studies
Risk Factors
Treatment Outcome
Reg. No./Substance:
0/Antihypertensive Agents; 62571-86-2/Captopril; EC

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